Division of Urology, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA.
Department of Urology, University of Illinois, Chicago, IL, USA.
Eur Urol. 2017 Aug;72(2):300-306. doi: 10.1016/j.eururo.2016.12.027. Epub 2017 Jan 13.
Renal cell carcinoma (RCC) with isolated lymph node (LN) involvement has historically been associated with poor prognosis. However, a subset of patients may experience long-term survival.
To examine the natural history of RCC with isolated LN involvement following surgical resection with long-term follow-up, and to evaluate clinicopathologic features associated with disease progression and survival.
DESIGN, SETTING, AND PARTICIPANTS: A total of 138 patients with isolated pN1M0 RCC underwent partial or radical nephrectomy and LN dissection from 1980 to 2010.
Partial or radical nephrectomy with LN dissection.
Metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Associations between clinicopathologic features and oncologic outcomes were evaluated using Cox regression models.
Median follow-up among survivors was 8.5 yr. The 5-yr and 10-yr MFS, CSS, and OS rates were 16% and 15%, 26% and 21%, and 25% and 15%, respectively. The median time to development of metastases was only 4.2 mo. On multivariable analysis, symptoms at presentation (hazard ratio [HR] 2.40; p=0.03), inferior vena cava tumor thrombus (HR 1.99; p=0.003), clear cell (HR 2.21; p=0.01) and collecting duct/not otherwise specified (HR 4.28; p<0.001) histologic subtypes, pT4 stage (HR 2.64; p=0.005), and coagulative tumor necrosis (HR 2.51; p<0.001) were independently associated with development of metastases. MFS rates at 1 yr after surgery were 71%, 63%, 33%, and 7% for patients with one, two, three, and four to five adverse features, respectively. Limitations include surgical selection bias.
Although isolated pN1 disease portends a poor prognosis, a small subset of patients experience durable long-term survival after surgical resection of isolated lymphatic metastases. Adverse prognostic features may enhance patient risk stratification and facilitate multimodal management approaches.
Although isolated lymph node metastases portend a poor prognosis, a small subset of patients experience long-term survival following surgical resection.
肾细胞癌（RCC）伴孤立淋巴结（LN）受累，既往与预后不良相关。然而，部分患者可能会长期生存。
通过长期随访，研究手术切除伴孤立淋巴结受累的 RCC 的自然病史，并评估与疾病进展和生存相关的临床病理特征。
设计、地点和参与者：1980 年至 2010 年，共有 138 例孤立 pN1M0 RCC 患者接受了部分或根治性肾切除术和淋巴结清扫术。
部分或根治性肾切除术伴淋巴结清扫术。
采用 Kaplan-Meier 法估计无转移生存（MFS）、癌症特异性生存（CSS）和总生存（OS）。采用 Cox 回归模型评估临床病理特征与肿瘤学结局的相关性。
幸存者的中位随访时间为 8.5 年。5 年和 10 年的 MFS、CSS 和 OS 率分别为 16%和 15%、26%和 21%、25%和 15%。中位转移时间仅为 4.2 个月。多变量分析显示，首发症状（风险比[HR]2.40；p=0.03）、下腔静脉肿瘤栓（HR 1.99；p=0.003）、透明细胞（HR 2.21；p=0.01）和集合管/其他未特指（HR 4.28；p<0.001）组织学亚型、pT4 期（HR 2.64；p=0.005）和凝固性肿瘤坏死（HR 2.51；p<0.001）与转移的发生独立相关。术后 1 年时的 MFS 率分别为 71%、63%、33%和 7%，患者分别有 1、2、3 和 4-5 个不良特征。局限性包括手术选择偏倚。
虽然孤立的 pN1 疾病预示预后不良，但一小部分患者在接受孤立淋巴结转移的手术切除后可获得长期持久的生存。不良预后特征可能增强患者的风险分层，并促进多模式管理方法。
虽然孤立的淋巴结转移预示预后不良，但一小部分患者在接受手术切除后可长期生存。
